[HSF] Too scared to touch.....
Donald Ross
donross at bigpond.com
Thu May 3 15:22:08 EDT 2007
My point had nothing to do with resources.
It just illustrates that severe coronary disease kills at any time.
When we had waiting lists we kept a record on cardiac deaths and they
did occur and most were not LMD.
MY POINT IS: that all these patients would be alive if they had had
in house surgery despite what some Canadian study purports to say.
Incidentally, I bet the Canadian study was funded by the mean
government which doesn't want to fund it's heath care appropriately.
Don.
> Don - so the spa hospital has 60 % left main and emergent TVD"s -
> you missed the point !!!
> Yes - you yourself are making a point with the statement
> "Do you really believe all Bojan's waiting list deaths had critical
> LM disease?"
> So - Do you think all waiting list deaths are left main disease -
> slightly rephrased and now does it appear the same ? Then that
> argument for left main itself becomes more tenuous !!
> I am not saying that left mains should all be operated when
> armegaddon comes but the reflex "in house" rush for surgery is more
> of a creation than a real necessity He can be operated at an early
> elective slot and doesn't really have to be rushed from the cath
> lab to the OR.
> Prasanna
>
> Donald Ross wrote:
>> Prasanna,
>> Indeed, a lot of what we practice will be found to be imperfect ,
>> but a lot of the so called evidence based practice is also bullshit.
>> Do you really believe all Bojan's waiting list deaths had critical
>> LM disease?
>> Remember the bikini and statistics?
>> Don
>>
>> PS It is great to have Hal onside for a change!
>>
>> On 02/05/2007, at 9:20 PM, psimha wrote:
>>
>>> Hal,
>>> Please read carefully, In never said anything about critical left
>>> mains.
>>> Also if you carefully see what I said I said where is the
>>> evidence . Some things that we practice need not necessarily be
>>> right.
>>>
>>> Prasanna
>>> hgrmd at aol.com wrote:
>>>> Don,
>>>> I agree with you. If Prasanna wants to send out critical LM's
>>>> or LAD's hanging by a hair after an MI, that's his business.
>>>> Around here, if such patient went home without surgery and
>>>> boxed, we'd definitely hear about it.
>>>> Hal -----Original Message-----
>>>> From: donross at bigpond.com
>>>> To: OpenHeart-L at lists.hsforum.com
>>>> Sent: Wed, 2 May 2007 4:40 AM
>>>> Subject: Re: [HSF] Too scared to touch.....
>>>>
>>>>
>>>> When they have LM or TVD + poor LV....... most of my patients. I
>>>> hope, therefore, you are not trying to put me out of a job? Don
>>>> On 02/05/2007, at 10:53 AM, prasannasimha wrote:
>>>>> Where in literature has it been shown that a patient who is
>>>>> stable > after an MI benefits from urgent in house
>>>>> revascularization ? Prasanna
>>>>> Donald Ross wrote:
>>>>>> Also, one wonders about the not infrequent peri-op AMIs during
>>>>>> non->> cardiac surgery that come our way for revascularisation
>>>>>> prior to >> discharge. Is this unnecessary surgery as well,
>>>>>> given it carries the same >> indications as regular coronary
>>>>>> surgery? Don On 01/05/2007, at 10:04 PM, Hgrmd at aol.com wrote:
>>>>>>
>>>>>>> Ajit, I invested the time it took to read all of Prasanna's
>>>>>>> >>> abstracts. I'm still not convinced that medical therapy
>>>>>>> with beta-blockers is >>> the way to go for nearly every
>>>>>>> case. Again, if a stress test in an asymptomatic >>> patient
>>>>>>> shows a lot of myocardium with reversible ischemia, it would
>>>>>>> be >>> potentially foolhardy not to cath that patient. Over
>>>>>>> the years, we've been >>> referred lots of patients with left
>>>>>>> mains or critical 3vd that were cathed prior >>> to an
>>>>>>> elective noncardiac procedure (usually carotid, ischemic leg,
>>>>>>> or AAA). >>> We did the CABG, they eventually got the
>>>>>>> vascular procedure, and they did >>> fine. I've yet to recall
>>>>>>> "graft closure" while the subsequent case was done. In >>>
>>>>>>> light of the problems with DES, the cardiologists are much
>>>>>>> more likely to use >>> bare metal stents in such scenarios. I
>>>>>>> do agree that beta blockade, possible Swan, and a competent
>>>>>>> >>> cardiac anesthesiologist suffice for the vast majority of
>>>>>>> cardiac >>> patients getting noncardiac surgery. However,
>>>>>>> there are plenty of asymptomatic >>> cardiac time bombs
>>>>>>> waiting to explode for those that never cath and treat >>>
>>>>>>> preemptively. Hal
>>>>>>>
>>>>>>>
>>>>>>> ************************************** See what's free at
>>>>>>> http://>>> www.aol.com.
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